Quality of care
What it means, and how Stanford Medicine continues to improve
Patients may get a bit apprehensive when they’re planning a stay in the hospital, but Lane Donnelly and Karen Frush want local residents to know they’re in good hands when they come to Stanford Medicine.
Donnelly, MD, is the chief quality officer for Lucile Packard Children’s Hospital Stanford, and Frush, MD, is the chief quality officer at Stanford Health Care. Both hospitals have been repeatedly ranked among the best health care providers in the nation by U.S. News & World Report and other organizations. One of the key factors in these rankings is the quality of care the hospitals deliver.
Quality of care takes into account a variety of measures, including rates of surgical complications or postoperative infections, using electronic systems for medication orders, patient mortality rates, the care and service patients receive in the hospital, and the average length of stay.
As an academic medical center with highly trained physicians in a broad range of specialties, Stanford Medicine treats some of the sickest patients in the country. Many patients come from other hospitals in the region because of the expertise and care that are available only at Stanford. Caring for the sickest patients means they are also most vulnerable to hospital-acquired infections.
Both hospitals have earned reputations for providing the highest levels of care to the most acute patient populations in the nation, and Donnelly and Frush say they are working with their teams to build new quality initiatives on the hospitals’ strong foundations.
“Over the past 15 years, we’ve learned a lot about the science of safety and quality,” said Frush, who joined Stanford Health Care from Duke University this summer. “Stanford — as a center for science, with so many amazing faculty and staff — has helped define that science. And one of the key things we’ve learned is that we can always get better.”
Donnelly, who came to Packard Children’s from Texas Children’s Hospital last November, oversees three areas for the children’s hospital: quality and safety, performance improvement, and patient experience. Donnelly said his teams in all of these areas work to achieve quality care and high value for patients.
“Ensuring the reliability of our processes is the foundation of providing high-quality care,” Donnelly said. “Through the performance improvement group, processes are continuously being evaluated and improved. And the patient experience team ensures that families are heard and that we use their feedback to continue to improve the health care experience.”
The renewed push for quality improvement
Frush and Donnelly say that safety and quality in health care are priorities that took on renewed importance in 2010 with the inception of the Affordable Care Act, which included measures for quality improvement. In March 2011, the Agency for Healthcare Research and Quality created a national strategy to guide quality improvement efforts at the local, state and national levels.
“Having an emphasis on quality and safety and a dedicated chief quality officer position is much more common now than it was 15 years ago,” said Frush, who is also a clinical professor of emergency medicine at the Stanford School of Medicine.
“Packard Children’s has always prioritized safety,” said Donnelly, who is also a professor of pediatric radiology at Stanford. “Our emphasis is on decreasing variation in the ways teams work to improve their respective areas.”
Over the past 15 years, we’ve learned a lot about the science of safety and quality.
A good example is Packard Children’s progressively decreasing rates of infections from central lines, which are catheters placed in large veins. Because of the move toward more standardized processes, the hospital has seen a 30 percent reduction in central line infections thus far in 2018. “While we won’t be satisfied until preventable harm is eliminated, we are encouraged by the progress,” Donnelly said.
Reducing central line infections has also been an area of focus at Stanford Health Care. In the past, central line catheters were sometimes inserted in the operating rooms. Now the insertions are done in the ICU, which has better infection-control mechanisms. Additionally, because infections are likelier the longer a catheter stays in the body, protocol at Stanford encourages care teams to remove the catheters as soon as possible.
In all, Stanford Health Care has more than 120 safety and quality initiatives in place. One of those initiatives focuses on pressure ulcers that develop on the skin or other tissues. Many intensive care patients are fed through nasal tubes. A nurse in one of the hospital’s ICUs developed a novel way to secure the feeding tube so it doesn’t press against the nose, thereby avoiding damage to the tissue.
In addition, Stanford Hospital has started using robots that disinfect rooms with pulsed xenon ultraviolet light to clean spots that are difficult and time-consuming to reach with traditional techniques. This technology has allowed cleaning staff to disinfect rooms quickly and efficiently.
Patients with complex needs
Donnelly also points to Packard Children’s history of excellence in providing quality care in its renowned specialty centers like those for transplant and complex cardiac care.
“These programs are among the largest in the country in volume and have the best clinical outcomes,” he said. “This has led to Packard Children’s being known for providing the highest quality care to the most complex pediatric medical population in the country.”
When asked what it takes to maintain a culture of safety, Donnelly said it involves “consistency and creating an environment where people feel comfortable speaking up. Historically, that has been a challenge with the hierarchical culture in the medical environment. But I think we are making great progress toward amending that.”
Frush agreed. “Ultimately, the goal for us is zero health-care-acquired infections,” she said. “If we all work together — physicians, nurses, residents in our training programs, researchers, safety and quality experts, environmental care staff, etc. — we can eliminate preventable infections. Nobody in health care will be satisfied until the preventable infection rate is zero. It takes a whole lot of effort, it takes new science and new technology, but it can be done.”